Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 105032 | MA |
NPI | 1003037342 |
---|---|
Provider Name | Ms. Wendy Fay Gillenson |
First Address | Roslindale, MA 02131-1404 |
Second Address | Lynn, MA 01901-1524 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2007 |
Last Update Date | 15/04/2015 |